Abstract

Well-described metabolic complications of HAART, i.e. hypercholesterolaemia, hypertriglyceridaemia, low HDL cholesterol, insulin resistance, and type 2 diabetes, have all been linked to an increased risk of cardiovascular disease. <BR>The incidence of MI correlates with longer exposure to HAART, hypercholesterolaemia, older age, smoking, prior history of cardiovascular disease and male sex. <BR>The absolute risk of cardiovascular disease remains low for most HIV-infected patients on treatment, except for those with other cardiovascular risk factors. <BR>Risk factors for dyslipidaemia in HIV-infected adults include the use of PIs, lipoatrophy, particularly with stavudine, increasing age, visceral adiposity and the use of efavirenz. <BR>PIs and NRTIs that induce lipoatrophy induce insulin resistance in HIV-infected individuals. Other risk factors for insulin resistance and diabetes include increasing age and visceral and central fat accumulation. <BR>All potential cardiovascular risk factors, including dyslipidaemia, diabetes, hypertension, smoking and family history, should be assessed before initiation of <BR>HAART, and then annually and within 1 - 3 months of any regimen change. <BR>Cardiovascular risk should not influence the timing of the initiation of antiretroviral therapy. <BR>A statin should be considered for isolated hypercholesterolaemia and a fibrate for isolated hypertriglyceridaemia. <BR>Simvastatin and lovastatin are contraindicated in patients receiving a regimen containing a PI.